Quitting Tobacco: What Works and What Doesn't with Michael Fiore

Dr. Michael C. Fiore, director of the Center for Tobacco Research and Intervention and a professor of medicine at the University of Wisconsin Medical School, will talk about the most -- and least -- effective means to quit smoking.

Event Date: 06/27/2000.

The opinions given by Dr. Fiore are his and his alone. If you have
specific questions or are concerned about your health, please consult your
personal physician. This event is for informational purposes only.

Moderator: Welcome to WebMD Live's World Watch and Health
News Auditorium. Today we are discussing Quitting Tobacco: What Works and What
Doesn't, with Michael C. Fiore, MD, MPH.

Fiore is the director of the Center for Tobacco Research and Intervention,
and a professor of medicine at the University of Wisconsin Medical School. He is
also the principal investigator on an NIH-funded Transdisciplinary Tobacco-Use
Research Center (TTURC) grant, "Relapse: Linking Science and
Practice." He formerly worked as a medical epidemiologist at the United
States Office on Smoking and Health, where he contributed to a wide range of
national research, educational and policy projects. He has also received
training as an Epidemic Intelligence Service (EIS) Officer for the United States
Centers for Disease Control (CDC). Dr. Fiore completed his undergraduate studies
at Bowdoin College and received his medical degree from
Northwestern University in Chicago.

Dr. Fiore, welcome to WebMD Live.

Dr. Fiore: Thanks for inviting me.

Moderator: Why should you quit smoking?

Dr. Fiore: Well, there's not a single health risk that poses
the same concern as tobacco use in America today. If we take three smokers and
line them up side by side, unfortunately one of those three are going to die
prematurely from a disease directly related to their tobacco use, losing, on
average, about 10 years of life. The reason to recommend smoking cessation is
that virtually all of these health risks are reversible upon quitting. We know,
for example, that tobacco use is one of the leading causes of heart attacks.
Upon quitting smoking, within one year, your risk of a heart attack is decreased
by 50%. Within five years, it returns to that of a person who's never smoked. In
terms of cancer risk, it takes a bit longer, Approximately 10-15 years to
approach that of a "never smoker." We can now say with confidence that
starting on the day you quit, you'll begin to feel better and the benefits of
quitting will continue for the rest of your life. There's probably not a single
more powerful health gift a person can give to themselves as successfully
quitting smoking.

Moderator: Why do the negative effects of smoking "wear
off" when you quit?

Dr. Fiore: Well, in fact, ALL
of the negative effects don't wear off. Unfortunately, the actual lung damage
that occurs in a person who develops emphysema, or what we now refer to as COPD (chronic
obstructive pulmonary disease),
is not reversible. But many of the effects result in changes that the body is
able to recover from, and the changes in the cardiovascular system are one
example of that.

Moderator: What is the first thing people need to do once
they've decided to quit?

Dr. Fiore: Well, you've already emphasized the first thing,
and that is to make a commitment to remove cigarettes from their lives. One
struggle that many people who smoke experience is the misconception on the part
of people who don't smoke that tobacco use is just some bad habit, and that if
the person had enough willpower, they should be able to quit on their own. Once
a person has made that commitment, based on the Public Health Service (PHS)
guideline
that was released today, the recommendation is to talk with your clinician. For
most people, quitting is a difficult process. But, with the right counseling
that a clinician can provide, as well as one of the right medicines that will
blunt the painful withdrawal symptoms that smokers experience, you can markedly
enhance your likelihood of successfully quitting.

Moderator: What are the symptoms of nicotine withdrawal?

Dr. Fiore: Nicotine withdrawal has a characteristic syndrome
that most smokers can describe. It consists of a series of experiences such as
irritability, difficulty concentrating, disturbed sleep, increased appetite, and
a physical craving for cigarettes. These symptoms usually begin within a few
hours to one to two days after quitting, and are greatest in the first week
after quitting. For most people, they then begin to decline, but in some, they
can continue for months. That actually is not clear -- why certain people have a
more prolonged withdrawal syndrome than others. But, it may be related to the
biochemistry that occurs in the brain of a person who smokes vs. a person who's
trying to quit. We know, for example, that the brains of smokers are objectively
different than those of non-smokers, particular in terms of a series of
neurotransmitters (brain chemicals) that change in the brains of smokers. This
can be related to why it's more difficult for some people to quit than others.